european innovation partnership on active and healthy ageing medicines optimisation best practice...
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European Innovation Partnership on Active and
Healthy AgeingMedicines Optimisation
Best PracticeProfessor Mike Scott
Pharmacy and Medicines Management Centre
Northern Health and Social Care Trust
Titanic Centre
30th January 2014 Belfast
Time line
2000-2004 Integrated Medicines Management (IMM)-patients over 65 years of age
2005-present Pharmaceutical Clinical Effectiveness
2006 - Safer Patient Initiative (International Healthcare Improvement (IHI) )
2010- present Innovation Programme
How was it initiated
Business case was produced indicating the work that was proposed
Resources required to undertake Process measures Clear outcome measures Research base methodology
How Was Political Support Obtained
Northern Ireland Executive Innovation Fund proposal (1999)
Citizen Benefits for older people predicated on previous local evidence
How was financial support secured
Executive programme funds Euro 720k first three years for the pilot
Based on positive outcomes further investment over the next five years Euro 4.8million
Return on Investment:
For very 3 euro invested per head of population 15 Euro returned
Innovation programme 840k Euro
Stakeholder Buy -in
All relevant stakeholders were involved at the outset
Integration of the key healthcare team members
In the Pharmaceutical Clinical Effectiveness Programme there is a multidisciplinary collaborative approach to reach consensus on clinical products based on safety and quality
Implementation of the technical solution
Comprehensive education and training Integration with medical and nursing colleagues in
both primary and secondary care Standard operating procedure development Documentation development Skill mix and role clarity Software development for both operational use and
process and outcome capture Robust research based methodology-University
linkage
How change management was implemented
Extensive pre implementation discussion with all key stakeholder groups
Workshops and presentations Roadshows Oversight group Operational group
AIM
To optimise the benefits that patients gain from prescribed treatments through innovative technology-supported solutions delivered through intra professional and intra sectoral systems change
Medicine Optimisation ObjectivesRight Drug
Selection
Matrix methodology
STEPSelect (Safe Therapeutic Economic Pharmaceutical Selection) optimise acquisition cost
Formulary management
Guideline development
Medicine Optimisation ObjectivesRight Patient
Re-engineered clinical pharmacy services in the hospital setting (older patients)(EPICS-Electronic Pharmacist Clinical Intervention System)
Focus on admission ,inpatient stay and discharge
Medicines appropriateness index Consultant care of the elderly pharmacists in
intermediate and nursing home settings Predictive risk modelling in the elderly
Medicine Optimisation ObjectivesRight Dose
Medicines reconciliation between sectors (Writemed software)
Medicines reconciliation between professionals
Medicines reconciliation at all transitions of care
Development of the Emergency Care Summary(ECS) and then Emergency Care Record(ECR)
Medicine Optimisation ObjectivesRight Time
Commitment to EIP –AHA to improve adherence to prescribed treatments
HSC assessment tools Adherence solutions both technological and
patient focussed e -health strategy Development of a technology supported
intervention via the Small Business Research Initiative(SBRI)
Results (1)
Reduced length of stay by 2 days Reduced readmission rate Reduced length of stay on readmission 5.8 days Improved Medicines Appropriateness Index (17.48
to 5.69) Reduction in 4.2 errors per admission kardex Reduced medicines administration error rate(8.3%
to 1.3%) Reduced discharge error rate from 22% to less
than 1%
Results (2)
Nursing home: Four interventions per patient Improved MAI Reduced costs of £48 per month per patient Reduced ED attendances PCE programme achieved 168 million Euro of
efficiency gains Improved satisfaction with the system by
patients
Added Value-Integrated working
Enhanced communication: Between health care professionals Between sectors Between community and voluntary sectors Traditional barriers broken down
Efficiency Effectiveness Sustainability
211 pharmacists and technicians have been trained across sectors
Northern Trust has a multi faceted adherence service
Software developments have improved the efficiency and effectiveness
In place for 13 years
Adoption in other countries
Learning visits testify to the recognition of the effectiveness and efficiency
Competitiveness Market Growth Economy
ENABLING TECHNOLOGIES;
STEPSelect - Digitalis Ltd Amsterdam
EPICS(Electronic Pharmacist Clinical Intervention System) –Yarra Software Ltd Belfast
Writemed (Medicines reconciliation software programme) -Yarra Software Ltd Belfast
Bespoke locker development -Hospital Metalcraft England
Competitiveness,Market Growth Economy
Clinical rules –Digitalis and Orbisch Medisch Centrum Sittard Netherlands
Intelligent Alerts - Yarra Software Ltd Belfast
Local Automated Microbiology Pharmacy Surveillance System (LAMPS) Yarra Software Ltd Belfast
Other HCAI related , Iskus Health- Dublin,Arran Healthcare –Dublin, Goldshield- USA
Success factors(1)
Early stakeholder engagement
Willingness to change systems and processes
Good strategic and operational oversight
Success Factors (2)
Robust methodology in terms of both clear process measures and outcomes
On-going reports and dissemination of progress including conferences and publications
Development of enabling technologies Quality improvement model of change
Success Factors (3)
Better engagement with researchers Better values and outcomes though
engagement with Pharma Concordance improvement though
partnerships with patients and carers Improved dialogue with the technology
industry Utilisation of Government innovation incentives
in pursuit of the health and well being agenda
Barriers to innovation
Underdeveloped pharmacy service focussing on distribution rather than patient facing
Lack of awareness of current system deficiencies by other healthcare colleagues and the skill set of pharmacy
Lack of technical staff Absence of training material Enabling technologies
Transfer Success
Another Trust in Northern Ireland Regional in Northern Ireland Numerous Trusts in England Uppsala in Sweden Skane in Sweden Tallaght Hospital in Southern Ireland Drogheda Hospital In Southern Ireland
Education and Training
Colleagues from Sweden Norway South of Ireland Erasmus programme with Poland Programme with the Spanish Hospital Pharmacists
Association Exchange programme with Orbisch Medisch Centrum
Sittard ,Netherlandss Jordan Numerous visits from English Colleagues New Zealand
Lessons Learnt
Realistic timelines Full stakeholder engagement and ownership Ensure that robust measures are determined at
the outset Awareness of the difficulties in developing
enabling technologies from both a hardware and software viewpoint
The importance of ensuring paper based methods work before automating
Identifying commercial partners
Action Plan(A1) Prescription and Adherence to Medical Plans
Improve patient adherence to care plans Empower patients and caregivers Deliver improvements in the healthcare
system to promote adherence Contribute to the research methodology on
ageing and adherence Foster communication between different
partners to improve adherence
Work to date
Delivered transferrable process changes in hospital and interface aspects
Delivered enabling technologies with EU companies
Delivered robust evidence Delivered enhanced communication
between key partners at transitions of care Initiated work on older patients in cohorted
settings in the community
Medicines Management Support Service Project
To improve outcomes form prescribed medicines by ensuring safety and quality in provision of adherence support for older people who are living in their own homes
NHSCT and SEHSCT ,Community Pharmacists
Medicines Management Support Service Project
Develop a referral mechanism Refine the assessment tool To identify a range of solutions Explore feasibility of monitoring and follow-
up Develop governance arrangements Problems –access,concordance,clinical
Small Business Research Initiative (SBRI)
For individual use For the use of people living in their own homes Tailored to the individual’s needs Easy to use Supported by monitoring and data tracking Capable of incorporation into patient care
pathways Capable of interface with HSC ICT systems
EIP
Valuable potential collaborators to complete the gap closure
Enables awareness of other work and a much more cohesive way to go forward
Building of links with other groups in your specific area via EIP members
Dissemination mechanism Formulate research questions Bids for Horizon 2020 funding
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